Violence

There were 63 papers reporting on SCI as a result of violence. 16 studies specifically cite gunshot wounds as a cause of SCI (table 10). 42 studies used data arising from hospital admission/discharge records which included either single or multiple hospitals. A total of 12 studies were based on national data from specifically designed SCI databases. Most of the studies were conducted in North America (Canada N=6; United States N=19) and Europe (N = 16). Asia had 12 studies, Africa had 6 studies, 2 studies were from Oceania, 1 from South America, and 1 from Russia.

In the USA, the proportion of SCI due to violence was found to range from a low of 0.97% (Fasset el al. 2007) to a high of 18.9% (Macciocchi et al. 2008). In Canada, reported proportions were mostly below 5%, with the exception of a recent study reporting a frequency of 8.2% based on data from the largest Canadian trauma centre (Pirouzmand 2010). In Europe, rates range from 1% in Germany (Exner and Meicnecke 1997) to 11.1% in Greenland (Pederson et al. 1989). Variation in the proportions is likely due to differences in both reporting and study population.

The proportions of SCI due to gunshot wounds among all causes of SCI are as high as 36% in South Africa (Hart and Williams 1994) 26.9% in Brazil (da Paz et al. 1992), 21.3% in Turkey (Gur et al. 2005), and 25.8 % in Jordan (25.8%) (Otom et al.1997). High rates of SCI due to gunshot wounds tended to be found in countries with warfare or high rates of violent crimes. Other commonly reported causes of SCI due to violence were knife wounds (N=10 studies) and assault in general (N=6 studies).